Organization
ROBERT S GENTILE ENTERPRISE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT S GENTILE O.D. (OWNER)
(912) 283-7171
Entity
Organization
Contact information
Practice address
1701 BOULEVARD SQ, STE C, WAYCROSS, GA 31501-8021
(912) 283-7171
(912) 284-9183
Mailing address
1701 BOULEVARD SQ, STE C, WAYCROSS, GA 31501-8021
(912) 283-7171
(912) 284-9183
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115254692C
—
GA
05
—
115254692D
—
GA
Enumeration date
01/11/2010
Last updated
06/23/2010
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